Payer Contracting Administrator

Job DescriptionJob Description

SunMED Medical is seeking candidates for our Payer Contracting Department. The ideal candidate will have prior experience working with payor contracts as well as experience with credentialing.

Responsibilities

• Work with Accounts Receivable on reimbursement or contract issues by reviewing any claims or other issues that we have with the Payers.
• Maintain and acquire new licensures as mandated by state, local and regional authorities as legally necessary including National Supplier Clearinghouse licensure updates.
• Reviewing all out of Network payers for new contracting opportunities.
• Obtaining and administering new state Medicaid plans and revalidating the agreements annually.
• Maintaining existing Payer contracts including Medicare.
• Obtaining and reviewing new payer information including medical policies, provider manuals, and claims information, including EFT’s, ERA’s, and EDI set ups and distributing to appropriate departments.
• Interact with payers and develop new business relationships to grow base of Payer Contracts, including Targeted Medicaid MCO’s, Medicare Advantage and Commercial plans.
• Organize and maintain all corporate information necessary in the credentialing process for existing and new payer agreements.
• Create and securely maintain all electronic and hard copy files of all existing and new payer, Business Associate and Network Administration Agreements.
• Create new, and maintain existing, CMS Forms 855S and Payer Portals 855B including revalidations and/or changes (i.e., locations/ownership, new products, etc.)
• Updating changes and renewing current information in System Award Management (S.A.M.).
• Create and maintain Payer Profile information sheets and distribute following monthly reporting meetings.
• Maintain and update . Payer reimbursement matrices for AOB/Upgrade amounts.
• Other duties as assigned

Qualifications

• Minimum of 3 years experience with payor contracting, credentialing and recredentialing.
• Knowledge of health insurance and general medical knowledge, including HCPCS and ICD-10 codes.
• Excellent time management skills with strong attention to detail
• Computer proficiency, along with the ability to type and work within Excel spreadsheets.

Further consideration on compensation possible based on experience.

Company DescriptionSunMED Medical is a nationally accredited provider of specialized medical equipment to patients in the home care setting.
We hold national as well as regional contracts with private insurance carriers as well as Medicare and Medicaid plans.Company DescriptionSunMED Medical is a nationally accredited provider of specialized medical equipment to patients in the home care setting. \r
We hold national as well as regional contracts with private insurance carriers as well as Medicare and Medicaid plans.

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